Outreach Education-Primary Musculoskeletal Trauma Care Course

IGOT has been working closely with Dr. Yinka Oloruntoba, the Chief of Orthopaedic Surgery at the Bedford Orthopaedic Centre in Mthatha, South Africa to develop a strategic plan to properly assess the burden of orthopaedic trauma in the Eastern Cape of South Africa with the purpose of developing and implementing an outreach, education intervention to meet the increased morbidity and subsequent disability from poor, non-existent, or inadequate treatment of trauma that increase this substantial burden to systems barely able to cope with HIV, TB Malaria, Malnutrition and poverty.

The objectives of this project are tiered. The initial objective is to assess the burden of orthopaedic trauma at a rural Orthopaedic Referral Hospital in the South Eastern Cape of South Africa (Bedford Orthopaedic Centre in Mthatha, South Africa). Based on this comprehensive observational and statistical assessment a curriculum was developed to be taught to rural providers at the outlying health care facilities, which refer patients to Bedford. This course will be introduced to the tertiary referral facilities over the span of 18 months. Dr. Oloruntoba, IGOT’s Faculty and UCSF Orthopaedic Residents are involved in the teaching of the course as well as the follow-up interventional data collection.

This project is designed to approach governing bodies with the goal of adopting an outreach course in adjunct to current requirements for providers in the rural setting, thus improving educational opportunities for treatment of orthopaedic trauma care.

Background

The South Eastern Cape of South Africa, particularly Mthatha, South Africa, presents a model of how a large, low-income, at-risk patient population can impact a hospital system with very limited resources. Mthatha has experienced an increase in population and motor vehicles without a corresponding increase in safety infrastructure. The large majority of orthopaedic trauma results from road accidents, falls and violence. The only orthopaedic department in the region is the 180 bed Bedford Orthopaedic Centre (BOC), part of the Mthatha General Hospital Complex that has approximately 1000 beds. Almost all referrals come from rural clinics and small hospitals that have limited resources to treat orthopaedic trauma. With over 3 to 4 million people living in the South Eastern Cape, BOC plays an essential role in managing and providing care for patients with orthopaedic injuries and musculoskeletal diseases such as tuberculosis, tumors and arthritis.

This enormous burden has introduced a demand for improved patient intervention at the referral sites, meaning better treatment at initial injury, which in theory would lead to subsequent less invasive and complicated intervention at the BOC. The outlying referral facilities that send orthopaedic trauma to the BOC have been identified to benefit from outreach education on how to improve orthopaedic trauma care and initial intervention.

Significance

The majority of patients served by the Mthatha Hospital Complex are unemployed or have very low incomes and almost all do not have health insurance. The burden of orthopaedic trauma will increase as the population migrates towards the greater Mthatha area. This burden must be met with a more organized and efficient system. BOC is a referral specialty hospital that can meet this burden and can serve as an example of how to properly address orthopaedic trauma in a resource-constrained setting. Collaboration with referral sites and implementation of an outreach educational course and thus increased communication will provide a foundation to meet this inevitable demand. The principles and concept of the study are universal and adaptable to serve as a pilot study that can be applied to the global increase in morbidity, mortality and subsequent disability caused by orthopaedic trauma especially in similar resource constrained settings.